集束救治策略在急性阿维菌素重度中毒的应用分析

目的改进急性阿维菌素重度中毒的救治方法。方法应用集束救治策略抢救急性阿维菌素重度中毒25例,主要方法包括：①清水洗胃,甘露醇导泻,尿毒清排毒。②预防性气管插管,保护性机械通气。③床旁血液灌流治疗。结果本组患者经7—16d治疗,治愈24例（96．0％）,死亡1例（4．0％）。血液灌流1次19例,2次6例。治愈者机械通气时间3.3．11．4d。结论集束救治策略是抢救急性阿维菌素重度中毒有效的急救措施。     

亚砷酸钠致Chang liver细胞氧化应激作用的研究

目的 研究不同浓度亚砷酸钠(NaAsO2)对人肝细胞株Chang liver的氧化应激作用.方法 采用四甲基偶氮唑(MTF)比色法检测NaAsO2(0、0.1、1、5、10、20、30、50、80、100、200 μmol/L)对Chang liver细胞活力的影响,利用2',7'-二乙酰二氯荧光素(DCFH-DA)检测细胞内活性氧(ROS)水平,利用黄嘌呤氧化法和硫代巴比妥酸比色法测定细胞内超氧化物歧化酶(SOD)活力和丙二醛(MDA)含量.结果 与对照组比较,0.1 μmol/LNaAsO2组细胞活力显著增强(P<05);10～200μmol/L NaAsO2浓度范围内,细胞活力随NaAsO2浓度升高而下降(P<0.05).在0～30 μmol/LNaAsO2浓度范围内,随着NaAsO2浓度的增高,细胞内ROS水平升高(P<0.05),SOD活力降低(P<0.001),MDA含量升高(P<0.001).结论 氧化应激可能是NaAsO2对Chang liver细胞毒性作用的机制之一.     

Studies on exposure status of inhabitants to water-arsenic valence states in areas with endemic arsenism in the Datong basin in Shanxi

This study aimed to describe the distribution of water-arsenic (As) valence states and its relationship to areas with endemic arsenism in the Datong basin. Drinking water samples of patients with endemic arsenism and a control group were examined using hydride generation atomic fluorescence spectrometry (HG-AFS). We analyzed the data using SPSS10.0 for Windows. The As(III)/As ratio was 52.1% in the water sample, exceeding the national standard of 0.05 mg/L. The As(III)/As ratio significantly varied among the different stages in the disease-state groups, and with the control group (χ ² = 22.4, P<0.01). The As(III)/As(V) ratio significantly varied in the four groups (χ ² = 26.19, P<0.01), with a tendency to increase along with the seriousness of the disease state. The most common type of drinking water arsenic valence state was As(III) in the endemic disease-areas. Endemic arsenism was positively correlated with As(III). This led us to conclude that the fraction of each water-arsenic valence state should be studied when determining the arsenic content of drinking water. Translated from Chinese Journal of Endemiology, 2006, 25(1): 64–66 [译自: 中国地方病学杂志]     

毒蕈中毒致急性肝衰竭3例

3例患者（男2例,女1例）,年龄分别为14、4、37岁,食用自采野生蘑菇1d后出现恶心、呕吐、腹痛、腹泻等急性胃肠道症状。经治疗上述症状无明显缓解,且出现肝及心肌损害。4d后3例患者均出现皮肤及巩膜黄染,实验室检查示ALT1101～6580U/L,AST715～1965U/L,TBil38.5～153.2μmol/L,DBil16.9～63.1μmol/L,IBil21.6～90.1μmol/L;LDH1036～2234U/L,CK-MB18～36U/L,CK30～669U/L。临床确诊为毒蕈中毒、肝衰竭。先后给予3例患者白蛋白透析、血浆置换及对症、支持治疗。住院14d后患者病情好转出院。     

铊中毒与急救的研究进展

稀有元素铊对人体的毒性因一系列中毒事件的出现而广受重视。近10年来,铊中毒的作用机制和救治措施成为研究热点。初步研究表明,铊经胃肠道、呼吸道和皮肤吸收后,在体内广泛分布,浓度最高的是肾脏,其次为唾液腺。以离子状态存在的铊可以取代体内的钾离子,影响钾离子参与的生理功能及神经信号传导,并影响一系列酶的活性,使之失去正常功能。此外,铊还能拮抗钙离子,从而影响心脏功能、与核黄素结合干扰生物氧化等途径。在临床上,铊中毒可见周围神经中毒症状、胃肠道症状、黏膜炎症、毛发脱落和视力受损等。24h尿液中铊浓度检测为评价铊中毒的最佳方法,尿铊〉5μg/L具有诊断意义。当前临床治疗措施主要是减少吸收、加速清除和对症治疗。最新研究表明,血液灌流能有效清除已吸收的铊。     

血必净联合甲强龙治疗百草枯中毒患者肺损伤的研究

目的评价血必净联合甲强龙治疗百草枯中毒患者肺损伤的临床疗效。方法选择我院急诊2004年1月-2008年9月收治的急性百草枯中毒患者51例,随机分为对照组(24例)与治疗组(27例)。对照组给予常规治疗。治疗组在对照组的基础上应用血必净注射液50mL,2次/d,连用7d;甲强龙500mg,1次/d,连用5d。结果治疗组发生低氧血症、Ⅰ型呼吸衰竭、ALI、ARDS、机械通气例数少于对照组,P<0.05;治疗组肺纹理增强、点片状影、磨玻璃影、胸腔积液、纤维条索、网状影、结节影表现明显少于对照组,P<0.05;治疗组入院后发生MODS、死亡数少于对照组,P<0.05。结论血必净联合大剂量甲强龙治疗可减轻肺组织损伤程度,降低患者死亡率。     

儿童急性中毒临床分析（附521例报告）

目的　研究儿童急性中毒的临床特征,以期寻求有效预防措施。方法　回顾性分析2012年1月至2017年1月西安市儿童医院消化科收治的因急性中毒住院的521例患儿的临床资料。结果　521例患儿中男性291例（55.9%）,女性230例（44.1%）;幼儿期257例（49.3%）,学龄前期147例（28.2%）;中毒地点在家中为508例（97.5%）,农村431例（82.7%）;中毒时间在夏季187例（35.9%）;中毒途径以消化道中毒为492例（94.4%）;及时治疗后,儿童急性中毒多数预后良好。结论　儿童急性中毒主要发生在婴幼儿和学龄前儿童;多发生在农村,夏季高发,以消化道中毒为主。     

Determination of paralytic shellfish poisoning toxins in Norwegian shellfish by liquid chromatography with fluorescence and tandem mass spectrometry detection.

A novel extraction and clean-up method has been developed for the determination of paralytic shellfish poisoning (PSP) toxins in shellfish samples. Raw shellfish material was extracted with an acidic acetonitrile/water (80:20, v/v) solution, whilst being homogenised. During the homogenisation the sample extraction solution was cooled with ice water. Subsequently, the extract was frozen at -20 degrees C for at least 4h. During freezing, two layers were formed, only the lower predominantly aqueous layer was used for the determination. The final extract solution was cleaned-up using a combination of Oasis HLB and Carbograph activated carbon SPE columns. The developed extraction and clean-up methods combined with gradient elution liquid chromatography (LC)-mass spectrometry/mass spectrometry (MS/MS) has resulted in a method which can determine the analogs GTX 1-5, C1-2, DcGTX 2-3, DcSTX, Neo, STX in a single analysis with an overall detection limit of 313mug STXdiHCL-eq./kg shellfish meat. The use of the developed extraction method with post-column high performance liquid chromatography (HPLC) with fluorescence detection (FLD) method provided an overall limit of detection of 89mug STXdiHCL-eq./kg shellfish meat for the same toxins. Both post-column HPLC-FLD and LC-MS/MS was used to investigate the Norwegian PSP toxin profile. It was found that the PSP toxins could be detected in shellfish samples from the Norwegian coastline for 10 months of the year, from March till December. The toxin profile consisted mainly of the carbamate toxins, GTX 1-4, Neo and STX, in terms of both concentrations and contribution to the overall toxicity. In addition, several of the n-sulfo-carbamoyl toxins were either detected in the samples at relatively low concentrations or their presence in the samples were indicated but could not be confirmed by the post-column HPLC-FLD and LC-MS/MS analyses.     

合理应用阿托品治疗急性有机磷农药中毒的临床研究

目的 :观察阿托品不同给药方式对重度急性有机磷农药中毒 (AOPP)的治疗效果。方法 :随机将 12 2例AOPP患者分为 A、B两组 ,A组 6 3例反复静推阿托品达阿托品化后 ,采用微量泵持续静脉输注 ;B组 5 9例采用反复静推阿托品 ,将治疗前后的疗效、阿托品用量及用药天数进行比较。结果 :阿托品用量及用药天数两组间无明显差异。A组治愈率 (96 .82 %)明显高于 B组 (83.0 5 %) (P<0 .0 5 ) ,死亡率 (3.17%)、阿托品中毒发生率 (1.6 %)、脑水肿发生率 (1.6 %)低于 B组 (P<0 .0 5 )。A组反跳的发生率低于 B组 (P<0 .0 1)。结论 :反复静推阿托品达阿托品化后 ,采用微量泵持续静脉输注阿托品治疗 AOPP效果明显。     

常见的化学性食物中毒的判断及预防

文章中介绍了常见的化学性食物中毒的毒素及中毒症状,针对每一种化学性食物中毒提出相应预防措施,并陈述发生食物中毒的应急处理措施。